Charge Item

$10 / year

The resource Charge Item describes the provision of healthcare provider products for a certain patient, therefore referring not only to the product, but containing in addition details of the provision, like date, time, amounts and participating organizations and persons. Main Usage of the Charge Item is to enable the billing process and internal cost allocation.

Complexity

Tracking Financial information is vital in Patient Administration and Finance systems in most Healthcare Organizations. The resource ChargeItem describes the charge for provision of healthcare provider products for a certain patient, therefore referring not only to the product, but containing in addition details of the provision, like date, time, amounts and participating organizations and persons. Main Usage of the ChargeItem is to enable the billing process and internal cost allocation. They are created as soon as the products are planned or provisioned, references to Encounters and/or Accounts can be maintained in a later process step.

The target of ChargeItem.definition may provide information on the Charge code such as pricing and inclusion/exclusion rules as well as factors that apply under certain conditions. In many cases however, this information may have been drawn from sources outside of FHIR depending on the distribution format of the code catalog. The ChargeItem assumes that such information is either implicitly known by the communicating systems or explicitly shared through the ChargeItem.definition. Therefore explicit pricing information is not shared within the ChargeItem resource. Also, the systems posting the ChargeItems are not expected to apply the rules associated with the charge codes as they may not know the whole context of the patient/encounter to evaluate such rules.

It lies within the responsibility of a billing engine, to collect the ChargeItems in the context of an Account or Encounter at a certain point in time (e.g. discharge of the patient) and to evaluate the associated rules resulting in some of the ChargeItems to be set to the status “not billable” in case the rules exclude them from being billed, or to create financial transactions according to base price and factors. Additional references to Encounter/EpisodeOfCare, Patient/Group and Services provide further context to help billing systems determine the appropriate account and establish the clinical/financial context to evaluate the rules associated with the charge codes.

This resource is not an actual financial transaction (such as an item on an invoice or any concise monetary amount being transferred from one Account to another) but is the base administrative data that may be used by a billing engine to create the financial transactions based on rules, factors and base prices associated with the charge code.

Unlike the Financial Transaction the ChargeItem primarily describes the provision, whereas the Financial Transaction documents cash flow. Therefore, the Financial Transaction results from ChargeItems created via the subsequent billing- or cost allocation process.

The actual financial transaction resulting from the evaluation of these rules against the clinical and financial context may be represented in formats appropriate to the financial realm. These are considered out of scope for the FHIR Standard, as they are not specific to the healthcare domain. The FHIR Claim resource does contain line items, and this ChargeItem resource provides the source material for the billing engine to create the items on the claim (which may be different due to business rules). This resource is referenced by itself and Invoice

Fast Healthcare Interoperability Resources (FHIR) is a draft standard describing data formats and elements (known as “resources”) and an application programming interface (API) for exchanging electronic health records. The standard was created by the Health Level Seven International (HL7) health-care standards organization.

Its goal is to facilitate interoperation between legacy healthcare systems, to make it easy to provide healthcare information to healthcare providers and individuals on a wide variety of devices from computers to tablets to cell phones, and to allow third-party application developers to provide medical applications which can be easily integrated into existing systems.

FHIR provides an alternative to document-centric approaches by directly exposing discrete data elements as services. For example, basic elements of healthcare like patients, admissions, diagnostic reports and medications can each be retrieved and manipulated via their own resource URLs (Uniform Resource Locators). FHIR was supported at an American Medical Informatics Association meeting by many EHR (Electronic Health Record) vendors which value its open and extensible nature.

Date Created

2018-09-20

Last Modified

2019-11-01

Version

4.0.1

Update Frequency

Annual

Temporal Coverage

N/A

Spatial Coverage

United States

Source

John Snow Labs; Health Level Seven International;

Source License URL

Source License Requirements

N/A

Source Citation

N/A

Keywords

FHIR, HL7, Medical Terminology, Processes Data, Processes Information, Processes Documentation, Health Information Exchange, Electronic Health Records, FHIR Smart, Smart on FHIR

Other Titles

FHIR Charge Item Resource, Electronic Health Records Exchange Through FHIR

NameDescriptionTypeConstraints
Concept_NameName of the concept in the FHIR structurestringrequired : 1
Computer_Ready_NameA Computer-ready name (e.g. a token) that identifies the structure - suitable for code generation. Note that this name (and other names relevant for code generation, including element & slice names, codes etc) may collide with reserved words in the relevant target language, and code generators will need to handle this.string-
TypeThe type the structure describes.string-
Dollar_RefThe Dollar_Ref ($ref) string value contains a Uniform Resource Identifier (URI) which identifies the location of the JSON (JavaScript Object Notation) value being referenced.string-
DescriptionA free text natural language description of the structure and its usestring-
ItemsThe value of the keyword should be an object or an array of objects. If the keyword value is an object, then for the data array to be valid each item of the array should be valid according to the schema in this value.string-
EnumThe enum is used to restrict a value to a fixed set of values. It must be an array with at least one element, where each element is unique.string-
RequiredThe value of the keyword should be an array of unique strings. The data object to be valid should contain all properties with names equal to the elements in the keyword value.string-
ConstThe value of this keyword can be anything. The data is valid if it is deeply equal to the value of the keyword.string-
Concept NameComputer Ready NameTypeDollar RefDescriptionItemsEnumRequiredConst
ChargeItemresourceTypeThis is a ChargeItem resourceChargeItem
ChargeItemid#/definitions/idThe logical id of the resource as used in the URL for the resource. Once assigned this value never changes.
ChargeItemmeta#/definitions/MetaThe metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
ChargeItemimplicitRules#/definitions/uriA reference to a set of rules that were followed when the resource was constructed and which must be understood when processing the content. Often this is a reference to an implementation guide that defines the special rules along with other profiles etc.
ChargeItem_implicitRules#/definitions/ElementExtensions for implicitRules
ChargeItemlanguage#/definitions/codeThe base language in which the resource is written.
ChargeItem_language#/definitions/ElementExtensions for language
ChargeItemtext#/definitions/NarrativeA human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety.
ChargeItemcontainedarrayThese resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently and nor can they have their own independent transaction scope.{'$ref': '#/definitions/ResourceList'}
ChargeItemextensionarrayMay be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension there is a set of requirements that SHALL be met as part of the definition of the extension.{'$ref': '#/definitions/Extension'}
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